Immediate control of life-threatening digoxin intoxication in a child by use of digoxin-specific antibody fragments (Fab)

Paediatric Anaesthesia
P HusbyO J Ohm

Abstract

Digoxin-immune antibody fragments (Fab) for treatment of digitalis intoxication was introduced in 1976. Many reports have been published concerning this therapy for children, but few have focused on its immediate reversal of cardiac as well as extracardiac life-threatening manifestations of digoxin toxicity. We present a case of life-threatening digitalis intoxication in a child with postoperative renal insufficiency, after a Sennings procedure for transposition of the great arteries. Digoxin administration according to the nationally recommended dosage and intervals unexpectedly resulted in serum levels in the toxic range. Severe cardiac arrhythmias, haemodynamic instability and a rapid-increasing serum potassium level resulted. This report demonstrates how administration of Fab according to the manufacturer's dosage recommendation reversed the tachyarrhythmia immediately and re-established a normal level of serum potassium within minutes.

Citations

Aug 5, 2014·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·B S H Chan, N A Buckley
Mar 11, 2005·Autonomic & Autacoid Pharmacology·A T Demiryürek, S Demiryürek
Sep 2, 2017·Journal of Postgraduate Medicine·D AnandhiV R Pandit

Related Concepts

Antibody Specificity
Cardiotonic Agents
Mapluxin
Electrocardiographic Recorders
Cardiac Surgery Procedures
Hyperkalemia
Fab Immunoglobulins
Postoperative Complications
Potassium
Transposition of Great Vessels

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